Transitional care in home care for older adult patients on antimicrobial therapy: patient profile and cost analysis
DOI:
https://doi.org/10.30968/jhphs.2025.164.1285Abstract
Objective: To describe the clinical and pharmacotherapeutic profile of patients discharged from hospital using Outpatient Parenteral Antimicrobial Therapy (OPAT) and oral sequential therapy (OST) in a hospital in Belo Horizonte. The study also aimed to analyze the costs related to these transitional care models. Methods: Cross-sectional study characterized as a partial economic evaluation of antimicrobial (ATM) treatment initiated during hospitalization and continued after discharge with ATM dispensation through OST or OPAT. The study was conducted in a public university hospital in Belo Horizonte, Minas Gerais. The study population included patients aged 60 years or older, hospitalized between January 2022 and December 2023. Demographic, clinical, pharmacotherapeutic, and pharmacoeconomic variables were described. The cost analysis was performed based on the difference between the cost of hospitalization required to complete in-hospital antimicrobial administration and the cost of hospitalization with home-based continuation of treatment through OST or OPAT. Results: During the study period, 67 elderly patients on ATM were discharged. The median age was 68 years (Min. 61; Max. 89) and the median length of stay was 14 days (Min. 1; Max. 138). Most patients were followed by the internal medicine team (56.7%), followed by the ophthalmology team (17.9%). The antimicrobial with the longest duration of use (92 days) and the most frequently dispensed (50.7%) was voriconazole. Regarding the costs analyzed for maintaining hospitalization of patients using ATM, teicoplanin showed the highest median (R$123,157.86), followed by vancomycin (R$52,645.80). For hospital discharge costs, the highest medians were observed for ertapenem (R$2,019.79) and teicoplanin (R$1,483.55). Conclusion: Hospital discharge with ATM dispensation for OPAT or OST showed potential for economic feasibility. The antimicrobials whose treatment by OPAT or OST contributed most to reducing hospital length of stay were voriconazole and teicoplanin. Care models involving OST or OPAT contribute to continued care for the elderly.
Downloads
References
1. Rangel MLSV. Processo de desospitalização e atenção domiciliar no Brasil e seus fatores associados. Res Soc Dev. 2023;12(4):e0612440793. doi: 10.33448/rsd- v12i4.40793
2. Simão ESM, Pacca JBCP, Hungria IC, et al. Dehospitalization: A Humanized Perspective on the Elderly. Braz J Dev. 2022;8(1):8002–18. doi: 10.34117/bjdv8n1-53
3. Silva RC, Queiroz MG, Grego Maia L. As perspectivas da desospitalização no Brasil e a assistência humanizada como coadjuvante neste processo: uma revisão de literatura. Bol Téc Senac. 2022;47(2):114–26. doi: 10.26849/bts.v47i2.882
4. Castro EAB, Lina van Keulen MS, Vieira CS, et al. Efetividade e custos de modelos de cuidados transitórios em atenção domiciliar: revisão integrativa. Rev Enferm Cent Oeste Min. 2024;v(14). doi:10.19175/recom.v14i0.5114
5. Reidy P, Breslin T, Muldoon E. Outpatient parenteral antimicrobial therapy (OPAT) across the world: a comparative analysis-what lessons can we learn? JAC Antimicrob Resist. 2024;6(4):dlae111. doi:10.1093/jacamr/dlae111
6. Rodriguez-Pardo D, Pigrau C, Campany D, et al. Effectiveness of sequential intravenous-to-oral antibiotic switch therapy in hospitalized patients with gram-positive infection: the SEQUENCE cohort study. Eur J Clin Microbiol Infect Dis. 2016;35(8):1269-1276. doi:10.1007/s10096-016-2661-5
7. Souza DM, Vasconcelos BF, Viana DMS, et al. Gestão de leitos em um hospital polo da região ampliada de saúde Jequitinhonha: aspectos organizacionais e operacionais do processo de trabalho. J Health Biol Sci. 2020;8(1):1–5. doi: 10.12662/2317-3076jhbs.v8i1.2819.p1-5.2020
8. Silveira RE, Santos S, Sousa MC, et al. Gastos relacionados a hospitalizações de idosos no Brasil: perspectivas de uma década. Einstein 2014;11(4):514-20. doi: 10.1590/S1679-45082013000400019
9. Ortiz-Mayorga JL, Pineda-Rodríguez IG, Dennis RJ, et al. Costos atribuidos a las infecciones asociadas con la atención en salud en un hospital de Colombia. Biomedica.2019;39(1):102–12. doi:10.7705/biomedica.v39i1.4061
10. Katz MJ, Roghmann MC. Healthcare-associated infections in the elderly: what’s new. Curr Opin Infect Dis. 2016;29(4):388-393. doi:10.1097/QCO.0000000000000283
11. Stewart S, Robertson C, Pan J, et al. Epidemiology of healthcare-associated infection reported from a hospital-wide incidence study: considerations for infection prevention and control planning. J Hosp Infect. 2021;114:10-22. doi:10.1016/j.jhin.2021.03.031
12. Mohammed SA, Alharthi A, Alharthy A, et al. A systematic review and meta-analysis of the cost-effectiveness of outpatient parenteral antimicrobial therapy. Heliyon. 2024;10(6):e31560. doi:10.1016/j.heliyon.2024.e31560
13. Morosini S, Marques APO, Leal MCC, et al. Costs and length of hospitalization for elderly residents in Recife-PE. Geriatr Gerontol Aging. 2011;5(2):91-98.
14. Freitas TC, Lima ACC, Andrade AGA, et al. Use of the stepdown strategy for dehospitalization and performance of outpatient parenteral antimicrobial therapy (OPAT) in transplanted patients. Braz J Health Rev. 2022;5(1):3134–3147. doi:10.34119/bjhrv5n1-274
15. Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis. 2021;73(5):e1029-e1044. doi:10.1093/cid/ciab549
16. Moraes EN, Reis AMM, Moraes FL. Manual de terapêutica segura no idoso. Belo Horizonte: Folium;2019.
17. Bourriquen M, Couderc AL, Bretelle F, et al. Effect of frailty on unplanned readmission in older adults: A systematic review. J Epidemiol Popul Health. 2024;72(5):202774. doi:10.1016/j.jeph.2024.202774
18. Sriskandarajah S, Hobbs J, Roughead E, Ryan M, Reynolds K. Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies. Int J Clin Pract. 2018 [Ahead of print]. doi:10.1111/ijcp.13216
19. Norris AH, Shrestha NK, Allison GM, et al. 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis. 2019;68(1):e1-e35. doi:10.1093/cid/ciy745
20. Rodrigues LP, Rezende ATO, Delpino FM, et al. Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis. Age Ageing. 2022;51(7):afac155. doi:10.1093/ageing/afac155
21. Xu X, Mishra GD, Jones M. Evidence on multimorbidity from definition to intervention: An overview of systematic reviews. Ageing Res Rev. 2023;89:101995. doi: 10.1016/j.arr.2023.101995
22. Loesch GH, Cruz JAW, Gasparetto J, Oliveira DDS, Telles JP, Tuon FF. Cost minimization analysis of outpatient parenteral/oral antibiotic therapy at a trauma hospital: Public health system. Infect Control Hosp Epidemiol. 2021;42(12):1445-1450. doi:10.1017/ice.2021.22
23. Oliveira PR, Felix CS, Carvalho VC, et al. Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil. Braz J Infect Dis. 2016;20(3):272–5. doi:10.1016/j.bjid.2016.03.005
24. Martins AAS, Casali AK, Fortes FMD, et al. Fusarium: o fungo responsável por causar cegueira em pacientes submetidos à cirurgia de catarata no Brasil em 2023 – uma revisão de literatura. Braz J Health Rev. 2024;7(4):e71402. doi: 10.34119/bjhrv7n4-122
25. Barlow G, Barr DA, Seaton RA. Outpatient parenteral antimicrobial therapy (OPAT) and the general physician. Clin Med. 2013;13(5):495–9. doi:10.7861/clinmedicine.13-5-495
26. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-177. doi:10.1086/510393
27. Bishop EJ, Tiruvoipati R. Management of Clostridioides difficile infection in adults and challenges in clinical practice: review and comparison of current IDSA/SHEA, ESCMID and ASID guidelines. J Antimicrob Chemother. 2022;78(1):21-30. doi:10.1093/jac/dkac404
28. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435-1486. doi:10.1161/CIR.0000000000000296
29. Freitas TC, Sousa JA, Oliveira AB, et al. Dehospitalization: pharmacoeconomic aspects and the impacts of days saved from hospitalization in renal transplant patients using carbapenems. Rev Bras Farm Hosp Serv Saude. 2023;14(3):994. doi: 10.30968/rbfhss.2023.143.0994
30. Shcherbakova N, Tereso G. Clinical pharmacist home visits and 30-day readmissions in Medicare Advantage beneficiaries. J Eval Clin Pract. 2016;22(3):363-368. doi:10.1111/jep.12495
31. Coffey A, Leahy-Warren P, Savage E, et al. Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review. Int J Environ Res Public Health. 2019;16(14):2457. doi:10.3390/ijerph16142457
32. Dimitrova M, Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses. BMJ Open. 2021;11(9):e049733. doi:10.1136/bmjopen-2021-049733
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to JHPHS : (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to JHPHS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
